Chemotherapy to blame?

Treatment: More patients are surviving cancer, but memory loss and other problems linger.

Medicine & Science

March 03, 2003|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

It started on a fall day, when Judy D'Avanzo forgot someone's name.

Then she couldn't keep track of her place in a novel, or whether she'd given her baby girl a bath. Soon, the journals she'd been given as gifts, the ones meant to record her feelings during breast cancer treatment, were instead inscribed with lists. Without writing down basic tasks and later crossing them off, the Timonium woman couldn't even remember if she'd taken her medicine.

Cancer patients have a name for this: chemo brain or chemo curse.

They describe memories wiped clean, glitches in thinking, subtle changes that researchers have confirmed in several small studies. But investigation of the phenomenon is still early. Doctors want more evidence, saying it is unclear that chemotherapy, and not other factors, is to blame. Patients are upset that physicians dismissed their symptoms.

"When you kind of start losing your mind a little bit, one would think that would rank pretty high up there, and they would have some answers," said D'Avanzo, 36. "But they don't."

In a world where more cancer patients survive for years, the issue is looming larger, and researchers are starting to focus on the quality of life after treatment. While many cancer patients return to normal lives, others are disabled by fatigue. Some experience tingling pain that persists for years.

And many are troubled by a new forgetfulness, a sense that their brains are in a fog.

"We are now beginning to look - at what cost are we curing individuals?" said Dr. Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute, formed to investigate the long-term consequences of cancer and cancer treatment for the 8.9 million survivors. "In the past, adults didn't live long enough to develop these problems."

What has started to emerge over the past few years, mainly in studies of breast cancer patients, is a pattern: subtle cognitive impairment in those who got chemotherapy. The evidence has come from tests of patients' vocabulary, memory and motor skills.

In one study of breast cancer and lymphoma patients from the Dartmouth-Hitchcock Medical Center, more than twice as many chemotherapy patients scored in the lower impaired range than did patients who had radiation or surgery.

Dr. Tim Ahles, who directs psycho-oncology research at Dartmouth, found deficits even after accounting for education differences and screening out survivors with problems such as depression and anxiety. Since both groups scored within normal ranges, though, researchers concluded the deficits are subtle.

But in a patient's life, those lower scores often mean much more: avid readers who no longer can finish a chapter, attorneys whose minds aren't nimble at trial, people like Judy D'Avanzo, who had to ask her husband the same question three times in 10 minutes.

D'Avanzo, who worked in marketing, told co-workers not to tell her anything in passing in the hallways, but rather wait until they could sit down and she had a notebook handy.

"When those simple things happen, they really become big things," said D'Avanzo, "because it's taking away control of your life."

Researchers say people with demanding jobs seem especially vulnerable. One Atlanta man who underwent chemotherapy for colon cancer returned to his job of 32 years as a senior consultant for a software company. While leading a training session he had taught dozens of times before, Jim Rusnell lost his train of thought and struggled to finish. Later, clients complained about his poor performance. Ultimately, Rusnell couldn't pass a basic certification.

"I'm sitting there with a master's degree in economics. This is fundamental stuff," said the 59-year-old man, "and I didn't understand it."

Doctors theorize the problems might affect people with various cancers, and the duration of the deficits differ. Some patients experience them during chemo treatments, while others deal with them for months after chemo is finished, prompting fears that the cancer has spread to their brain. Ahles' research showed that a subgroup, perhaps 20 percent or 30 percent, showed deficits 10 years later.

Oncologists said they're particularly interested in how early-stage breast cancer patients are affected by chemotherapy. In recent years, many more thousands of these women have received chemotherapy, not as treatment, but to prevent recurrence - even though their risk of that is small.

Skeptics say even though it is clear some patients have some cognitive deficit, pinning it all on chemotherapy is too easy. First, there are dozens of chemotherapy drugs, given in many doses and combinations. None of the studies has measured the patients' skills before treatment, so comparisons are not available. And oncologists say patients are under stress, they're on various medicines, they're not sleeping well.